Bottom Line:
Anti-tumor necrosis factor alpha (TNF-α) therapy has re-defined our treatment paradigms in managing patients with Crohn's disease (CD) and ulcerative colitis.Longitudinal follow-up studies have also shown that responsiveness to infliximab therapy also correlates well with reduced rates of hospitalization, and surgery for complication of long-standing active disease, including stricture and fistulae formation.The pediatric experience has been instructive in suggesting that the early introduction of anti-TNF-α therapy may perhaps alter the natural history of CD in children, an observation that has stimulated a great deal of interest among gastroenterologists who care for adult patients with CD.

Affiliation: Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA;

ABSTRACTAnti-tumor necrosis factor alpha (TNF-α) therapy has re-defined our treatment paradigms in managing patients with Crohn's disease (CD) and ulcerative colitis. Although the ACCENT studies showed proven efficacy in the induction and maintenance of disease remission in adult patients with moderate to severe CD, the pediatric experience was instrumental in bringing forth the notion of "top-down" therapy to improve overall clinical response while reducing the risk of complications resulting from long-standing active disease. Infliximab has proven efficacy in the induction and maintenance of disease remission in children and adolescents with CD. In an open-labeled study of 112 pediatric patients with moderate to severe CD, 58% achieved clinical remission on induction of infliximab (5 mg/kg) therapy. Among those patients who achieved disease remission, 56% maintained disease remission on maintenance (5 mg/kg every 8 weeks) therapy. Longitudinal follow-up studies have also shown that responsiveness to infliximab therapy also correlates well with reduced rates of hospitalization, and surgery for complication of long-standing active disease, including stricture and fistulae formation. Moreover, these children have also been shown to improve overall growth while maintaining an effective disease remission. The pediatric experience has been instructive in suggesting that the early introduction of anti-TNF-α therapy may perhaps alter the natural history of CD in children, an observation that has stimulated a great deal of interest among gastroenterologists who care for adult patients with CD.

Mentions:
Although the principal goal of therapy is to induce and maintain an effective disease remission, the intestinal mucosa will often show ongoing inflammation that contributes to frequent relapses and less than favorable maintenance of clinical remission. Since CD may progress from intestinal inflammation to strictures and penetrating disease, including fistulas and abscess formation, mucosal healing has become a primary treatment objective. Since delayed puberty and growth failure is seen in 15% to 40% of pediatric patients with CD,4 achieving normal growth and development also represents an important end-point to therapy. The ultimate goal is to achieve and sustain an effective disease remission that avoids complications associated with long-standing and unremitting disease. To achieve this clinical objective is of paramount importance in order to improve patient quality of life, and avoid psychological complications, including anxiety, and depression. Given the myriad of potential therapies available to treat patients with CD, it has become increasingly important to select those medications with the most favorable benefit risk ratio that will minimize the overall need for corticosteroids (Figure 1).

Mentions:
Although the principal goal of therapy is to induce and maintain an effective disease remission, the intestinal mucosa will often show ongoing inflammation that contributes to frequent relapses and less than favorable maintenance of clinical remission. Since CD may progress from intestinal inflammation to strictures and penetrating disease, including fistulas and abscess formation, mucosal healing has become a primary treatment objective. Since delayed puberty and growth failure is seen in 15% to 40% of pediatric patients with CD,4 achieving normal growth and development also represents an important end-point to therapy. The ultimate goal is to achieve and sustain an effective disease remission that avoids complications associated with long-standing and unremitting disease. To achieve this clinical objective is of paramount importance in order to improve patient quality of life, and avoid psychological complications, including anxiety, and depression. Given the myriad of potential therapies available to treat patients with CD, it has become increasingly important to select those medications with the most favorable benefit risk ratio that will minimize the overall need for corticosteroids (Figure 1).

Bottom Line:
Anti-tumor necrosis factor alpha (TNF-α) therapy has re-defined our treatment paradigms in managing patients with Crohn's disease (CD) and ulcerative colitis.Longitudinal follow-up studies have also shown that responsiveness to infliximab therapy also correlates well with reduced rates of hospitalization, and surgery for complication of long-standing active disease, including stricture and fistulae formation.The pediatric experience has been instructive in suggesting that the early introduction of anti-TNF-α therapy may perhaps alter the natural history of CD in children, an observation that has stimulated a great deal of interest among gastroenterologists who care for adult patients with CD.

Affiliation:
Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA;

ABSTRACTAnti-tumor necrosis factor alpha (TNF-α) therapy has re-defined our treatment paradigms in managing patients with Crohn's disease (CD) and ulcerative colitis. Although the ACCENT studies showed proven efficacy in the induction and maintenance of disease remission in adult patients with moderate to severe CD, the pediatric experience was instrumental in bringing forth the notion of "top-down" therapy to improve overall clinical response while reducing the risk of complications resulting from long-standing active disease. Infliximab has proven efficacy in the induction and maintenance of disease remission in children and adolescents with CD. In an open-labeled study of 112 pediatric patients with moderate to severe CD, 58% achieved clinical remission on induction of infliximab (5 mg/kg) therapy. Among those patients who achieved disease remission, 56% maintained disease remission on maintenance (5 mg/kg every 8 weeks) therapy. Longitudinal follow-up studies have also shown that responsiveness to infliximab therapy also correlates well with reduced rates of hospitalization, and surgery for complication of long-standing active disease, including stricture and fistulae formation. Moreover, these children have also been shown to improve overall growth while maintaining an effective disease remission. The pediatric experience has been instructive in suggesting that the early introduction of anti-TNF-α therapy may perhaps alter the natural history of CD in children, an observation that has stimulated a great deal of interest among gastroenterologists who care for adult patients with CD.